Pathways HES Information How To Use Useful Links

Pathways Personal Hygiene Seating Beds Pressure Care Slings

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Useful Links

• www.hertfordshire.gov.uk

• Pressure Care-NICE guidance

• HCC guidance on equipment

• ELMS

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• These icons will take you to the next item along the equipment ladder or to other relevant information

• Use the ‘Back to Contents’ button to exit the ladder at any

time

What is HES

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How to order

How to order

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• HES is the community equipment service for Hertfordshire.

• Jointly funded by Hertfordshire County Council and NHS CCGs

• Provides equipment to service user to enable them to maintain independence as well as to enable/prevent hospital discharge/admission.

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HES Information • HES is the community equipment service for Hertfordshire.

• Jointly funded by Hertfordshire County Council and NHS CCGs

• Provides equipment to service user to enable them to maintain

independence as well as to enable/prevent hospital discharge/admission.

Personal Hygiene

Bathing

Showering

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Bath/ Shower Board

• Criteria for loan

• General considerations to be satisfied.

• Service user is unsafe to stand and step into the bath.

• Service user agrees following discussion

• Service user’s seated trunk control is sufficient to support balance

while lifting legs in/out of the bath.

• The edges of the bath have sufficient width between tiles and the

inside edge of the bath to safely support the board (40mm).

• Service user does not already have satisfactory bathing/showering

provision.

Swivel Bather

• Criteria for loan • General considerations to be satisfied. • Service user to be able to wash/shower from the seat. • Not to be used if the intention is to reach the bottom of the bath. • Service user can lift legs over the sides of the bath, independently or with

minimal carer assistance. • Service user does not already have satisfactory bathing/showering

provision. • Service User agrees following discussion

Bath Lift • Criteria for loan

• General considerations to be satisfied.

• Standard bath equipment (e.g. bath boards/seats/rails) have

been tried or considered, and deemed inadequate or

inappropriate by the prescriber.

• Other bath top equipment (e.g. swivel bather) has been

considered and deemed inadequate or inappropriate by the

prescriber.

• The service user is able to transfer onto the proposed

equipment independently or with the assistance of a carer.

• The service user has a preference and/or a need for a full

use of a bath as opposed to over bath shower.

• The equipment is likely to meet the service users’ needs in

the long term or a reasonable period if the service user has

a terminal diagnosis.

• Bath lifts should not be issued as an interim solution

pending a major adaptation.

• Service user does not already have satisfactory

bathing/showering provision.

Shower Stools

There is sufficient space in shower There is sufficient storage space

Piping in Walls is not an issue

Freestanding Shower Stool

Criteria for loan

General considerations are satisfied.

Service User agrees to use of the equipment following discussion

Points to consider

Is there space in the shower for the stool

If others use the shower, is there storage space outside the

shower

Weight limits

Wall Mounted Shower Stool

• Criteria for loan

General considerations are satisfied.

Service User agrees to use of the equipment following discussion

Due to installation risks relating to pipes use a standard shower stool

when possible.

.

Combined Commode/ Shower chair

Criteria for loan

General considerations to be satisfied.

Service user requires assistance to transfer on/off shower seat.

Service user uses wheelchair for indoor mobility

A level access shower is in situ or is approved and installation is

planned.

A static shower chair has been considered and deemed

inadequate or inappropriate.

Service User agrees to use of the equipment following discussion

Service user does not already have satisfactory

bathing/showering provision.

Modular Shower Chair

Criteria for loan

The person is unable to stand in a shower & needs additional

support from arms/back/feet.

Service User agrees to use of the equipment following discussion

The person is unable to maintain a safe seating position in a

standard shower chair.

The person needs to shower regularly due to medical need or

incontinence

Service user agrees to loan following discussion

General considerations have been satisfied

A level access shower is in situ or is approved and installation is

planned.

A static shower chair has been considered and deemed

inadequate or inappropriate.

Service User agrees to use of the equipment following discussion

Service user does not already have satisfactory

bathing/showering provision.

Tilt-in-space Shower Chair

Criteria for loan

The person is unable to stand in a shower & needs additional

support from arms/back/feet.

The person needs to shower regularly due to medical need or

incontinence.

The person is unable to maintain a safe seating position in a

standard shower chair.

The person needs to be hoisted in to the shower chair & this

cannot be achieved in a standard upright shower chair.

Discussions have been had with service user and they agree to

loan.

General considerations have been satisfied.

Service User agrees to use of the equipment following discussion

Seating

Sit to Stand Seated Pressure Relief

Sit to Stand

Chair height inappropriate Issues raising from seat

Seat Raisers

Criteria for loan

The service user should be assessed as so substantially and

permanently restricted in their mobility that functional ability is

gained only from a chair with a seating lever higher than their

current chair or an assisted lift.

The service user would gain functional ability by the provision

of suitable seating, or less strain would be put on the carer.

The person needs additional assistance to rise from a low chair

and their safety is being compromised.

To alter angle of chair & promote pressure relief/ postural

drainage

The chair itself is not at the correct height.

Service User agrees to the loan of the equipment following

discussion .

General considerations to have been satisfied.

Ladder Approach

Alternative chair in users own home

Fixed blocks should be considered first

Discuss whether service user would prefer to purchase correct

height chair

Next Item (SU has arm strength )

Next Item (SU lacks and arm strength)

Foam Wedge

Criteria for loan

The person needs support to sit up in bed to meet their care,

posture and/or pressure needs and their safety is being

compromised.

The person has a medical need which cannot otherwise be meet

e.g. postural drainage, respiratory failure.

The person needs to alter the angle of their seating to promote

transfers or seating position posture.

The person needs to raise their legs/ankles/feet for an identified

medical reason.

Service User agrees to use of the equipment following discussion

General considerations have been satisfied.

Standing Aids

Criteria for loan

Service user requires extra assistance to rise from chair.

General considerations have been satisfied.

Foam wedge insufficient.

Service user requires something to push off to stand.

Existing chair only has one armrest.

Service User agrees to use of the equipment following discussion

Elevator Cushion

Criteria for loan

The person cannot rise from sit to stand position in order to

mobilise and their safety is being compromised.

The service user would gain functional ability by the provision of

suitable seating.

General considerations have been satisfied.

Service User agrees to loan of the equipment following

discussion

Chair Raiser- Electric Unit

Criteria for loan

The person cannot rise from sit to stand position in order to

mobilise and their safety is being compromised.

The service user would gain functional ability by the provision of

suitable seating

Service User agrees to use of the equipment following discussion

Standard seat raisers do not work.

General considerations have been satisfied.

Points to Consider

The chair to be modified must be stable and in reasonable

condition.

Only one chair or settee as preferred to be modified.

If chair raisers are fitted, the service user should be informed not

to move the chair.

Beds

Lying on a bed to seated Standing to Seated Seated to Lying Seated to Standing

Pressure Care

Sliding Sheets

Types

Slide Sheets

Satin Sheets

Criteria for loan

General considerations have been satisfied

Service user agrees, following from discussions

Carer is available

Low pressure care needs

Satin Sheets- Service user has to able to roll

The person cannot rise from sit to stand position in order to

mobilise and their safety is being compromised.

The service user would gain functional ability by the provision of

suitable seating.

General considerations have been satisfied.

Service User agrees to loan of the equipment following

discussion

Bed Raisers

Types

System raisers

Blocks

Criteria for loan

General considerations have been satisfied.

The service user should be assessed as being so restricted in

their functional ability that they are unable to transfer on/off bed

at its current height.

The service user would gain independent functional ability by the

provision of a suitable raising unit, or that less strain would be put

on a carer.

The bed needs to be raised to allow a mobile hoist to be used to

transfer the service user.

Discussions with service user lead to agreement for loan

Blocks must be considered before system raisers.

Bed is suitable to be raised

Bed Rails Criteria for loan

General considerations are satisfied

Service user agrees to loan following discussions

Service user has sufficient grip strength, trunk control, and ability

to reach.

Points to Consider

Bed rails should not be used as a restraint to prevent a service

user from getting out of bed. Assistive technology support should

be sought for service users who wander.

3rd party bed rails may not be compatible with other items of

equipment fitted to a bed. A full assessment of all the service

users’ requirements relating to the bed should be undertaken, not

just a bed rails assessment.

Certain Types of pressure relief may require extra height bed

rails.

Installation of bed rails normally requires that the service user is

NOT in the bed. In exceptional circumstances bed rails can be

fitted to a community profiling bed while the occupant is in the

bed.

Cannot put a “parnel” on a privately purchased profiling bed

HES will not deliver unless they receive confirmation and

evidence that a proper risk assessment has taken place.

Back Rest Criteria for loan

General considerations are satisfied

Service user agrees to loan following discussions

Pillow Elevator Criteria for loan

General considerations are satisfied

Service user agrees to loan following discussions

Mattress Elevator Criteria for loan

General considerations to have been satisfied

Service users function is not sufficient to sit up from lying without

assistance and where no other equipment will meet this need.

The service user’s condition requires them to spend significant

amounts of time in bed and they are unable to change position

independently.

The service user has sufficient balance and trunk control to use it

safely.

The provision of a mattress elevator/pillow lifter would diminish

the amount of disturbance and/or strain experienced by the carer,

where no other equipment will address this.

Service user agrees to loan following a discussion

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Leg Lifter Criteria for loan

General considerations to be satisfied.

The service user is unable to independently lift their legs onto the

bed and other options have been considered and deemed

inappropriate.

The service user has sufficient sitting balance and trunk strength

to maintain a sitting position while their legs are raised by the leg

lifter.

The service user is able to ‘bottom shuffle’ and can adjust their

position onto the bed once their legs have been raised.

Service user agrees to loan following a discussion.

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Electric Leg Lifter Criteria for loan

General considerations to be satisfied.

The service user is unable to independently lift their legs onto the

bed and other options have been considered and deemed

inappropriate.

The service user has sufficient sitting balance and trunk strength

to maintain a sitting position while their legs are raised by the leg

lifter.

The service user is able to ‘bottom shuffle’ and can adjust their

position onto the bed once their legs have been raised.

Service user agrees to loan following a discussion.

Electric should only be loaned if service user lacks the ability to

use the manual sling

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Profiling Bed Criteria for loan • The person requires a positioning bed to meet their care, posture and/or

pressure needs and prevention of shear forces. • The person has a medical need which cannot otherwise be meet e.g.

postural drainage, respiratory failure • Service user is in Last Days of Life and other solutions not applicable due

to time. • Short term solution to enable hospital discharge • Bariatric units only available if service user is over [insert weight here] or

approved by a specialist moving and handling advisor in HES. Personal comfort is not a criteria for loan of bariatric units.

• Enables independent transfers where other solution would not e.g. for wheelchair users

• Service User agrees to use of the equipment following discussion . • General considerations have been satisfied.

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Bariatric Profiling Bed Back to Contents

Criteria for loan

The person requires a positioning bed to meet their care, posture

and/or pressure needs and prevention of shear forces.

The person has a medical need which cannot otherwise be meet

e.g. postural drainage, respiratory failure

Service user is in Last Days of Life and other solutions not

applicable due to time.

Short term solution to enable hospital discharge

Bariatric units only available if service user is over [insert

weight here] or approved by a specialist moving and

handling advisor in HES. Personal comfort is not a criteria

for loan of bariatric units.

Enables independent transfers where other solution would not

e.g. for wheelchair users

Service User agrees to use of the equipment following discussion

General considerations have been satisfied.

Low Profiling Bed Back to Contents

Criteria for Loan

The person requires a positioning bed to meet their care, posture

and/or pressure needs and prevention of shear forces.

Risk of wandering.

The person has a medical need which cannot otherwise be meet

e.g. postural drainage, respiratory failure.

Height adjustable bed is required to support carers (informal

and/or formal) and/or may reduce or remove care package.

Service user is in Last Days of Life and other solutions not

applicable due to time.

Short term solution to enable hospital discharge.

Bariatric units only available if service user is over [insert weight

here] or approved by a specialist moving and handling advisor in

HES. Personal comfort is not a criteria for loan of bariatric units.

Enables independent transfers where other solution would not

e.g. for wheelchair users

Service User agrees to use of the equipment following

discussion.

General considerations have been satisfied.

Ultra-Low Profiling Bed Back to Contents

Criteria for Loan

Service user is at risk of rolling/falling out of bed and needs to be

lowered to floor to avoid this

The person requires a positioning bed to meet their care, posture

and/or pressure needs and prevention of shear forces.

The person has a medical need which cannot otherwise be meet

e.g. postural drainage, respiratory failure

Height adjustable bed is required to support carers (informal

and/or formal)

Service user is in Last Days of Life and other solutions not

applicable due to time.

Short term solution to enable hospital discharge

Bariatric units only available if service user is over [insert weight

here] or approved by a specialist moving and handling advisor in

HES. Personal comfort is not a criteria for loan of bariatric units.

Enables independent transfers where other solution would not

e.g. for wheelchair users

Service User agrees to use of the equipment following

discussion.

General considerations have been satisfied.

Manual Handling Belt Back to Contents

Turning aid Back to Contents

Criteria for loan

General considerations to be satisfied.

Assessment by a qualified clinician (Clinician has identified that

the carer/service user is at risk while completing essential

transfers).

Service user has consistent standing tolerance / weight bearing.

Service user is able to hold onto the handle and able to maintain

posture throughout the manoeuvre.

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Transfer aid

Criteria for loan

General considerations to be satisfied.

Assessment by a qualified clinician (Clinician has identified that

the carer/service user is at risk while completing essential

transfers).

Service user has consistent standing tolerance / weight bearing.

Service user is able to hold onto the handle and able to maintain

posture throughout the manoeuvre.

Standing Hoist Back to Contents

Criteria for loan

General considerations are satisfied

Service User agrees to use of the equipment following discussion

Carer available and capable to use.

Service user must be able to weight bear to use standing slings

The service user is confined to a chair/wheelchair or bed and is

unable to make independent transfer and/or weight bear, or their

ability fluctuates such as weight bearing is unpredictable.

A carer has been assessed by a qualified clinician to be at risk using

their present method of transfer or an agency carer is deemed to be

at risk following a risk assessment.

The service user is using unsafe transfer methods.

There is adequate space within the room/property to allow for

appropriate manoeuvrability when using the hoist.

The carer is able to manoeuvre the hoist, given the type of floor

covering and/or threshold, and is able to apply slings correctly.

The chair and bed can interface with the hoist immediately or after

reasonable modification.

The hoist is to be used as a means of transfer, not to transport the

client from room to room.

Prescriber is able to give a demonstration on operating (see manual

handling policy).

Foam Overlay Back to Contents

Criteria for Loan

The service user has been fully assessed by a practitioner whom

has clinically indicated the use of this therapy in the prevention of

pressure ulceration

The service user has evidenced risk of developing pressure

damage

Carers, informal and formal, are instructed on use by a health

practitioner.

Waterlow Score: 10-14

Ulcer Category: 1,2

General considerations have been satisfied

Service User agrees to use of the equipment following discussion

Air Overlay Back to Contents

Criteria for loan

The service user has been fully assessed by a practitioner whom

has clinically indicated the use of this therapy in the prevention of

pressure ulceration

The service user has evidenced risk of developing pressure

damage

Carers, informal and formal, are instructed on use by a health

practitioner.

General considerations have been satisfied

Service user agrees to use of equipment following discussion

Waterlow Score: 15-20

Ulcer Category: 1,2

Air-Replacement Mattress Back to Contents

Criteria for loan

The service user has been fully assessed by a practitioner whom

has clinically indicated the use of this therapy in the prevention of

pressure ulceration

The service user has evidenced risk of developing pressure

damage

Carers, informal and formal, are instructed on use by a health

practitioner.

General considerations have been satisfied

Service user agrees to use of equipment following discussion

Waterlow Score: 15-20

Ulcer Category: 1,2

Foam Cushion Back to Contents

Criteria for loan

The person cannot rise from sit to stand position in order to

mobilise and their safety is being compromised.

The service user would gain functional ability by the provision of

suitable seating

Service User agrees to use of the equipment following discussion

Standard seat raisers do not work.

General considerations have been satisfied.

Points to Consider

The chair to be modified must be stable and in reasonable

condition.

Only one chair or settee as preferred to be modified.

If chair raisers are fitted, the service user should be informed not

to move the chair.

Air Cushion Back to Contents

Criteria for loan

The person cannot rise from sit to stand position in order to

mobilise and their safety is being compromised.

The service user would gain functional ability by the provision of

suitable seating

Service User agrees to use of the equipment following discussion

Standard seat raisers do not work.

General considerations have been satisfied.

Points to Consider

The chair to be modified must be stable and in reasonable

condition.

Only one chair or settee as preferred to be modified.

If chair raisers are fitted, the service user should be informed not

to move the chair.

Alternating Air Cushion Back to Contents

Criteria for loan

The person cannot rise from sit to stand position in order to

mobilise and their safety is being compromised.

The service user would gain functional ability by the provision of

suitable seating

Service User agrees to use of the equipment following discussion

Standard seat raisers do not work.

General considerations have been satisfied.

Points to Consider

The chair to be modified must be stable and in reasonable

condition.

Only one chair or settee as preferred to be modified.

If chair raisers are fitted, the service user should be informed not

to move the chair.

Pressure Care Back to Contents

Chest Sling Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Transport Sling Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Intermediate/unreliable weight bearing capacity

Comfort Sling Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service User cannot tolerate being lifted under the shoulders.

Standard Sling Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service user is not weight bearing

Toileting Sling Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service user is not weight bearing

Sling with head support Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service user is not weight bearing

High Backed Sling Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service user is not weight bearing.

Risk with head support/ less trunk control

Padded and Slip Easy Sling Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service user is not weight bearing.

Application and Tissue Viability issues

Slings Back to Contents

Standard In-Chair Sling Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service user is not weight bearing.

Frequent transfers and frequent use

In Chair Sling w/Leg Split Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service user is not weight bearing.

Frequent transfers and frequent use

Leg pressure and pain management needed.

Please Note:

Sling has toilet aperture

In Chair Sling with extensor loops Back to Contents

Criteria for loan

Service user meets criteria for a hoist (see hoist criteria).

Assessment has been undertaken by a qualified clinician.

The person needs to be transferred/repositioned using a

hoist/stand aid.

Standard or universal slings should be explored and excluded

before progressing to more specialist slings.

Second slings maybe required due to continence, bathing, and

transfer surfaces/ locations (slings should follow service user

between location unless for children at school).

Service user agrees to loan following discussions.

Length of time and frequency of use.

General considerations have been satisfied.

Service user is not weight bearing.

Frequent transfers and frequent use.

Full support needed and issues with repositioning.